muchmorewherethatcamefrom

Healthcare Hot Potato

In My thyroid, Peanut, Tolkien on September 24, 2013 at 3:23 pm

Oh you poor neglected blog you! I’m glad you’re not a baby human, and I’m sure Child Protective Services is too.

So how’ve you guys been? Things at Casa Much are trucking along. Update, you ask? Oh, you didn’t? Well, since I’ve already started …

On the thyroid front, when I went for my 1-year follow-up in February, my endocrinologist told me I would need to go through treatment again. For a variety of reasons (not even including the utter hassle it would be) this was concerning to us:

a) because of repeat radioactive iodine’s potential effects on fertility or implications for a future secondary malignancy

b) because of the fact that this recommendation did not follow published American Thyroid Association treatment guidelines, and

c) because of the inability to get a clear explanation from my endocrinologist about why he was recommending this. We seemed to have a tough time understanding each other in person (English was not his first language), and he totally ignored an e-mail I sent with my questions.

This latter issue was the straw that broke the camel’s back for me. I know just how chaotic a physician’s day in clinical practice can be, but I have never failed to respond in some way to a patient’s e-mail or phone call. I would have absolutely understood if he didn’t have the time to write out a four-page reply and if he had instead asked me to come in to discuss it — no problem at all there. But to pretend a patient has not communicated with you is unacceptable. So that was when I decided it was time to try to find another endocrinologist. But to pinpoint someone who takes our insurance, is located within 50 miles of us, has expertise in thyroid cancer, and has an opening within the next few months is a daunting task. Eventually, however, I did find someone, a doc who actually graduated in Tolkien’s and my medical school class, although he joined towards the end of our time at school so we didn’t know each other. As well, Dr. Med School Classmate (Dr. MSC) and I have a very close mutual friend who I’ll call Dallas Cowboy (these nicknames are cracking me, if nobody else, up) who also vouched for him. Dr. MSC turned out to be awesome. Really kind and helpful, even after I tortured him with endless questions, and he felt we could do some testing first rather than going right into a repeat round of treatment (which was what Tolkien and I also thought was the best plan.)

So there I was, friends, blissfully skipping along in the care of a new, sane endocrinologist, my long search over. It just so happened that Dallas Cowboy and his wife came to Easter services with Tolkien and I later that month. When we were leaving brunch together in the same car, Dallas Cowboy’s cell phone rang. “Look,” he said, “it’s Dr. MSC!”

“Oh!” I said. “Tell him I said hi!”

And why do you think Dr. MSC was calling Dallas Cowboy? Why, to tell his good friend some exciting news, of course: that he was moving. To join another practice. Out of state.

What are the odds I’d be present to actually hear that phone call sending me back to square one? You can’t make this stuff up! Of course I didn’t blame him at all and I was happy for his opportunity, but I needed a nap just thinking about starting my search anew.

So there I was back at the aforementioned square one: needing to find a new endocrinologist. (For those of you keeping track at home, this would be Endo #4 in the course of one year.) I was out of options as far as covered providers under my insurance, so I had no choice but to go back to [prominent academic hospital.] However, I wanted to see a different physician there since I’d had a less than satisfactory experience with the one prior to Dr. MSC. But roadblock! The endocrinology department at this hospital has an unusual policy — they do not allow you to switch providers without express consent from the first one. What? I’d have to ask my original, less-than-awesome doctor for permission to switch like a meek child, explain to his face why I was uncomfortable with his care, and then abide by his final judgment over whether I could stay or go? It’s not even like we have socialized healthcare in this country — I’m paying my own money for insurance and for these appointments, and it’s clear that the payor system treats patients as as consumers. And as one of those consumers, I still have no choice?

Luckily Dr. MSC trained at said hospital and very kindly offered to intercede on my behalf. (He also told me that he’d had multiple patients switch from Less-Than-Awesome Doctor to him over the course of his time there, which may be why the hospital has this policy in place to begin with, to ensure that Less-Than-Awesome Doctor doesn’t end up with no patients at all.) One endocrinologist did agree to see me, but his office still insisted that I had to write a letter to my original guy. Which I did, simply being grateful that I didn’t actually have to have an awkward conversation with him. (Never heard back from him.)

Several months later, I finally saw Endo #4, who seems very nice. He, too, felt that a second round of treatment was not warranted without some other testing first. In fact, he felt that another round of treatment was so far out of the bounds of standard practice that I must have misunderstood Less-Than-Awesome Doctor, since LTAD has an accent. I was not thrilled by this suggestion. Although I fully admit, as stated above, that he was not easy to understand, I am the child of immigrants — I’m not exactly scared away by accents. And I know what he recommended because I asked him a million incredulous questions about it. Anyway, it’s all water under the bridge now. More important is that Endo #4 then casually mentioned, after some varied comments about the weather, that he was moving … to Rome.

People, IS IT ME???? Should I start showering? Am I singlehandedly, one by one, driving all endocrinologists out of my state? Can they sense my unhealthy obsession with L. M. Montgomery? Should I instead start carrying around a copy of, I don’t know, The Art of War or some other universally “cool” tome as a talisman against loss of healthcare providers?

All is not lost, however, for two reasons. One is that Endo #4 is just taking a temporary professorship and should be back in the States next spring. The second is that all testing and treatment for me is on hold for now anyway, because of this:

Peanut #2

Yes, I currently have a uterine buddy. We are super-excited for this new addition (especially Peanut, who wants to know when her baby is finally going to exit my stomach into her smothering care) and are praying hard for a safe delivery and healthy baby. Baby Boy (I’m currently taking suggestions for his blog nickname … anyone?) is due in early December, and I’m trying to ignore all the people who have told us that going from 1 to 2 children actually increases your work by more than 100%. We’re concentrating on less important things at the moment, such as name selection. Boys’ names are hard! Forget blog nickname suggestions, anyone have real-life name suggestions? What did you guys name your sons? We are not above theft.

So no more news on the thyroid front for awhile (I hope), for a very welcome reason. I can’t believe that, after 4 years, we are re-entering the baby phase. It’s time to stop procrastinating, get out all that baby gear, and re-learn how to use it. You know, tomorrow.

Mishmash

In Books, Christianity, My thyroid, Peanut, Tolkien on February 21, 2013 at 2:54 pm

I am so impressed with these mommy bloggers who post every day and still have fed and clothed children. Where do they find the time? I’d be patting myself on the back if I could post once a week.

Since I am not there yet, though, let me give you a quick update on what’s been going on over the last couple of months, category-style:

1. Tolkien – Seeing the light at the end of the tunnel. Only 4 months left of residency, and then only a year of fellowship before our decade of combined medical training is finally over. It’ll be tough for awhile yet — he’s currently cramming for the first of 3 board exams over the next 18 months, which means even less time he’s able to spend with us — but we can’t help but feel a bit encouraged.
2. Peanut – “Mama,” she told me after receiving excessive hugs and kisses while she wanted to be doing something else, “I have TOO MUCH LOVE.” What a problem. She is the poster child for gender differences being inborn and not environmentally determined, given her sudden and random development into a fashionista. She is currently obsessed with skirts and dresses and how her hair should be done. We’re puzzled about where this has come from. I’ll admit I really like fashion, but given that I now work from home, she doesn’t see me dress up that much, so I don’t think she’s getting it from me. Tolkien lives in scrubs and doesn’t wear ribbons in his hair (to my knowledge.) So, school? It’s a mystery. I don’t like too much of an emphasis on physical appearance, especially for girls (I want her to place her value on her brain and her soul), but I also don’t want to be a killjoy, so I’m trying to go with it in moderation for now. I also took her ice skating for the first time recently, something we did all the time growing up in Canada (and I am no athlete), and it was a moderate success, in that no one ended up in the hospital.

In her salwar kameez

In her salwar kameez

There’s nothing wrong with wall-hugging. Or hogging.

3. Me – Had my 10-month thyroid cancer follow-up yesterday, and my endocrinologist says we need to go through all of it again in a few months — the low-iodine diet, radioactive iodine, isolation — for some long and boring reasons. A big bummer. As always, your prayers would be appreciated!
4. To be filed under “Divine Timing” – Tolkien and I took our first vacation in 5 years two weeks ago, by going on a Carnival Caribbean cruise, just days before the ill-fated Carnival Triumph took its most famous voyage. We had a fantastic time, which is lucky, because I’m pretty sure that if I had seen feces dripping down walls that I would never, ever, ever go on vacation again. Like, ever.

St. Thomas, U.S. Virgin Islands

St. Thomas, U.S. Virgin Islands

5. Favourites – I love reading quizzes people fill out, so here’s a quick one on me. If you feel so inspired, send me your answers to these questions! Really, I find them fascinating.

Favourite colour: Red and purple
Favourite number: 17
Favourite book: Way too many to list. Here are some that come to mind immediately. My disclaimer is that this list is in no way inclusive, and that some titles are listed not because of their literary greatness but because of their exceptional creativity.
The Blue Castle, L.M. Montgomery
The Count of Monte Cristo, Alexandre Dumas
The Screwtape Letters, C.S. Lewis
The Likeness, Tana French
Encyclopedia of an Ordinary Life, Amy Krause Rosenthal
The Murder of Roger Ackroyd, Agatha Christie
Rebecca, Daphne du Maurier
Favourite food: Chocolate, French fries, raspberries
Favourite exercise: Oh dear
Favourite herb: Dill. I came to dill late in life, but now I adore it. I credit this recipe with lighting the fire of my love. It’s actually addictive.
Favourite current TV shows: The Office (though it’s not what it once was, my loyalty shackles me), Downton Abbey
Favourite meal out, ever: It’s funny, as there are so many wonderful meals we’ve had over the years. But for some reason, one that really stands out is a delicious meal Tolkien and I had 9 or 10 years ago at Nawab, an Indian restaurant in Roanoke, Virginia. It was nothing short of amazing that an ethnic restaurant in an area not known for its ethnic diversity could create such a perfect tikka masala, naan and lassi, from start to finish.
Favourite animal: Zebras? Because of the symbolic nature of their black and white skins and how harmoniously they create a whole? I’m stretching here. Seems I don’t care much for animals.
Favourite quote: “For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.” Romans 8:38-39
Favourite chore: Washing dishes. And cooking, if that can be considered a chore.

6. Speaking of cooking, some of our favourite recent recipes:

2012-10-27_18-37-52_221

Vegetables being prepped for Balsamic Roasted Vegetable Soup (I’m not a huge fan of soup, so I never think to make it. But Tolkien is, so one day I decided to search out a recipe. This disappeared fast.)

Pink Oreo-stuffed chocolate chip cookies for Peanut’s class Valentine’s Day party.

2013-02-17_19-21-04_453

Pistachio-encrusted broccoli pesto salmon and mushroom orzo.

… and much more, of which I have no photographic evidence. I would invest in a better camera, but then I’d need to remember to use it to take pictures of things. Dilemma!

7. Collective treat for the day – A must-watch clip of the Downton Abbey cast doing a spoken-word performance of One Direction’s “What Makes You Beautiful.” You’re welcome.

A Post for Gun-Rights Activists

In Politics on December 18, 2012 at 5:05 pm

http://www.bradycampaign.org/xshare/pdf/facts/Brady_GodBlessAmerica.pdf

There are some issues that seem very black-or-white to the people who find them important. Gun control is one of those issues for me. It’s always seemed obvious to me why eliminating firearms (yes, I’m going to go there) is the right thing to do. But in the past, I could let it go. So 2nd Amendment proponents don’t agree with me. Fine. Live and let live. Except here’s the thing — they’re literally not letting us live. Disagreement on this crucial issue is costing us our lives. 4 days ago, 20 kindergartners were murdered in Newtown, Connecticut. (Along with 7 of their adult protectors — let’s not give them short shrift just because they were lucky enough to grow up before dying.) The bile rises in my throat whenever I read about this horror and injustice. What can we do? we all ask ourselves. Well let’s start by calling opposing gun control what it really is: a moral atrocity. And let’s stand up and take down the offensive arguments the gun lobby has systematically and coldheartedly promoted. (Gun activists, please read this. If you are so certain about what you believe, you shouldn’t be afraid of what I have to say.)

  • Owning firearms is my right. It’s in the Constitution.

Indeed it is your legal right, if you are an American. As a Canadian, I can tell you that the idea that any person is entitled to own a lethal weapon seems patently absurd. I mean, you have the specified right to own a gun but not, say, health insurance or a refrigerator, which are actually useful and much less likely to harm someone? That the government would even comment on this one object is bizarre. So why did they? Because the Founding Fathers intended to allow citizens to protect themselves from tyranny. Nothing else. If you are a gun-rights activist, do you imagine that the government today, in 2012, is coming after you? And if it is, do you actually believe that your pathetic little store of firearms will stop them? It won’t and you know it, so your gun stash is not there to protect you from tyranny. I read somewhere that in the 1700s, it took a full 30 seconds to reload your gun after firing one shot. A mass killing using guns back then was virtually impossible. Do you think for one second that, if the Founding Fathers were alive today, they would stand for the 2nd Amendment being used for massacres — school massacres, at that? If so, you are, frankly, delusional.

As it is said, “Your right to swing your fist ends at the tip of my nose.” The fact that guns are legal increases the chance that I will be shot while buying groceries. (You can’t argue this. These mass shootings happen far more frequently in this country than in any other. How many can we count this year alone?) Therefore my right to life and liberty is less important than your right to pack heat. If you are a gun-rights activist, at least be man enough to admit that.

  • Timothy McVeigh used fertilizer to kill people. I guess we should ban fertilizer, knives and cars too.

Except that fertilizer, knives, cars and anything else you can think of each have other, legitimate, useful purposes. The only purpose of a gun is to maim or kill. Additionally, a gun makes it possible to kill many more people, in much less time, than anything else. How many people do you think you could kill with a candlestick before being overpowered? One? A perfect example is the tragic school attack in China just hours before the Newtown massacre. The perpetrator used a knife and had 23 victims. Guess how many died? None.

  • Guns don’t kill, people do.

I love this one. Do you live in a world where pistols go rogue and run around shooting at each other while their owners aren’t looking? Every gun that kills someone had a person at the other end of it.

  • Banning guns won’t stop criminals from having them.

Since when is the difficulty in enforcing a law reason not to write the law in the first place? Last I noticed, murder is still illegal in the U.S., but it keeps happening. Why don’t we legalize murder, and drugs then, since people keep using them? As a pain management physician, I can tell you how incredibly difficult it is to keep people from misusing their medication. Yet we don’t just throw up our hands and say, “You know what? Writing these prescriptions and drug-testing you is a real pain. From now on, you take as much Percocet as you want!”

We create laws because a) they act as a deterrent for criminal behaviour (not as an eliminator), and b) they give us recourse to punish people when they break them. If guns were illegal except for law enforcement officers, police would be able to confiscate any firearm they came across. Gun producers would be shut down. Any intelligent person can see that simply in terms of sheer numbers, gun prevalence would decrease. With fewer guns, you have fewer shootings. I’m not saying no shootings. I’m saying fewer shootings.

  • We need guns to protect ourselves.

This conjures up the image of the nice, law-abiding citizen confronting an intruder in their home and thankfully having their trusty gun to protect their sleeping family. Except that’s not how it usually works. Most “self-defense” gun violence is between people who know each other, where the reality of who is defending and who is offending is not at all clear. Of all self-defense handgun homicides in 1997 for example, according to the FBI Supplementary Homicide Report, only 2.3% were ruled justifiable homicides by civilians. Which means the other 97.7% turned out to be just plain homicides. And that’s not taking into account how often guns in the home are used in suicides or accidental injuries/deaths.

  • Banning guns won’t stop violent crime. Crazy people don’t obey laws.

It’s exactly because crazy people don’t obey laws that we shouldn’t give them the tools to break them. If a murderous person wants to be murderous, why would we not do everything in our power to prevent them from accessing a lethal weapon when it has no other possible use? Yes, they could kill with a car, but they can also drive to and from work in a car. The only thing they can do with a weapon is injure or kill. There is a serious moral failing in being lukewarm about preventing gun sales to the mentally ill because it might infringe on your own gun rights. You are therefore saying it is fine with you that the rest of us are at risk every day.

As an aside, I totally agree with those who are calling for an overhaul of this nation’s mental health system. They are absolutely right. The current ultimate treatment for the mentally ill in the U.S. is prison. That can’t continue. That being said, why are the vast majority of mass murderers men? If mental health was the only contributor, the number of female killers should be almost equal.

  • Guns are a fun hobby. There’s nothing wrong with hunting.

For those of us who are not vegetarians, we don’t have a problem with hunting. In a more moderate mood, I might be willing to concede that guns, when genuinely used for humane hunting with the goal of obtaining food for consumption or sale, might have a place in modern society. But if the gun lobby is so unwilling to be moderate, then I am too. There’s no way to adequately police whether people are using their guns only for hunting food. So take them away. If I loved knitting, and knitting needles were being used in multiple mass killings of innocent bystanders, then I would gladly give up my hobby if there was a chance one fewer person would be killed. Because I’m, you know, a compassionate human being.

  • The solution to gun violence is more guns. If the victims had been armed, this wouldn’t have happened.

If anyone is actually saying this after this most recent tragedy in Newtown, we are not having a discussion with intellectual equals. Do you really think we should put lethal weapons into the hands of kindergartners? And to suggest that teachers should be armed is just laughable. The NRA has really shown its simultaneously sociopathic and infantile worldview on this one. What happens when the school bully, or even the class clown, pinches his gym teacher’s pistol(s)? After the Virginia Tech killings (an event that hit close to home for our family, since my father-in-law has worked there for 30 years and my brother- and sister-in-law were freshmen in lockdown on campus that day) some gun activists suggested that the university should be allowing students to carry weapons, to which a professor promptly replied that he would resign from teaching immediately. Why do people who put forth this argument never acknowledge that human beings are volatile? All it takes is one disagreement, one bad day, and your self-control can be weakened. For some people, it might take a lot to get them to actually brandish their gun. For others, it might not take much. How the heck would we know who is who?

  • We don’t know if changing gun laws will actually do anything.

So is that a reason not to even try? But the truth is that actually we do know. There was another New Town mass shooting once, in New Town, Australia in 1996. 12 days later, gun control laws were put into place. There have been no mass shootings in Australia since. By now we have all seen the statistics: every other industrialized country in the world has strict gun laws and nowhere near the gun violence the U.S. does. This New York Times article takes a succinct look.

The simple fact of the matter is that America’s gun culture puts all of us at risk. I am at risk, you are at risk, our precious children are at risk of being slaughtered every single day … at school, in the movie theatre, at a gas station … because anyone around us may have a gun and could snap. Gun activists, how long will you put your heads in the sand? Does this not matter to you? Will it only matter to you if your own child is murdered by a madman? Will it even change your mind then? The Onion had a headline to the effect of “Nation realizes this is just something that happens now.” Understand this — if you support guns, you are saying you are OK with that. If there is any chance that eliminating guns could decrease the number of homicides in this country, you should be supporting gun control. And if your reaction to the Newtown school shooting was not wondering how to stop this from continuing to happen but how to make sure your gun rights aren’t affected, you are, quite frankly, a bad person. There’s no other way to say it. You are a bad person and you will have to answer to God for it. This New Yorker article says it well: that people who argue against gun control have made a clear moral choice, that the comfort they derive from carrying a weapon is more important than the safety of innocent children.

Bringing up God, by the way, is another interesting avenue. When I first moved to the U.S. I was incredulous (and still am) that the political party known for gun advocacy is the same party supposedly affiliated with the Christian Right. How can this be? Do any of us honestly believe God is pro-gun? And how on earth can you be anti-abortion but pro-2nd Amendment? You care about an unborn child but not the children we already have with us? I am anti-gun because I am pro-life. I care about all lives, not just some. I’ve also read that Anne Graham quote that says for years we’ve been telling God to get out of our lives, so we cannot have it both ways and simultaneously demand his blessings. Let me state here that I agree with her. When God is not the centre of our lives, chaos will naturally ensue, and as a society we cannot expect to do well. But to apply that quote in this context as an argument that guns were not the cause is offensive, both to the victims and to our collective intelligence. God gave us brains so we would use them. Only after we have done everything we humanly can to prevent such horror (such as eliminating weapons and access to them) can we sit back and say that this is all about our poor relationship with God. It’s like saying that a person died in a head-on collision because he had rejected God. Well OK, that might be true, but perhaps his not wearing a seatbelt also had something to do with it.

It is not OK that I have to live with a higher risk of losing my child because you love your guns. If your misplaced loyalty to a killing machine didn’t affect me, I could leave you to it. But it does. If your weapon gets into the wrong hands (and those wrong hands might be yours, for all I know), anyone in my family could be dead. That alone is reason enough to get rid of the weapon. There is no advantage to owning a gun that trumps the safety of the rest of us.

Gun activists, if you are still not convinced, and if you still believe yourself to have a shred of humanity, look at this Washington Post slideshow. Do not bury your head in the sand. If you believe guns are great, at least be big enough to own it. Look into the eyes of these innocent, dead people. Imagine what it must be like to be five years old, to see your small friends shot to death before your very eyes, to see your teacher slaughtered while trying to shield you, to be so terrified that you vomit all over yourself and lose control of your bladder, to scream for your mommy and daddy whom in fact you will never see again in this life, to feel a bullet rip through your own tiny body. Have the courage to imagine that scene and to recognize what it says about you that you still believe it’s more important for you to own guns than for kindergartners to be protected.

When I was getting my baby dressed for school Friday morning, those parents in Connecticut were doing the exact same thing. A few hours later, mine came home. Theirs did not. How will any of us survive if our children are next? Fellow gun-control advocates, what are we going to do about this?

UPDATE: Another great article laying out the simple truth. Withholding gun control is like withholding antibiotics, and we’re allowing a bunch of crazies to do just that. How I hope that this author is right, and that one day soon gun control will be as ubiquitous, and its rightness as universally accepted, as seatbelts and smoking bans. Especially because seatbelts (although I’m all for them, of course) generally only help the people wearing them (it’s rare that you’re going to kill someone else by not wearing a seatbelt) but gun control would protect us all. And how I hope that the NRA’s sunset is near, and that they’ll soon be thought of in the same category, and understood to be as evil and anachronistic as, the KKK.

Follow

Get every new post delivered to your Inbox.